Gastroenterology

Gastroenterology

Volume 134, Issue 2, February 2008, Pages 396-404
Gastroenterology

Clinical–Alimentary Tract
Effect of Abuse History on Pain Reports and Brain Responses to Aversive Visceral Stimulation: An fMRI Study

https://doi.org/10.1053/j.gastro.2007.11.011Get rights and content

Background & Aims: Abuse history is common in irritable bowel syndrome (IBS) and is associated with greater pain reporting, psychologic distress, and poorer health outcome. These effects may be mediated by enhanced responses to aversive visceral stimuli. We investigated the effects of IBS and abuse history on pain reporting and brain activation in response to rectal distentions. Methods: Ten female patients with IBS and 10 controls were included. Half of patients in each group reported a history of abuse. Brain functional magnetic resonance imaging (fMRI) images and pain ratings were obtained during rectal distentions. Statistical parametric mapping identified activation in subregions of the dorsal cingulate cortex and covariation with rated pain. Results: (1) Distention-elicited pain correlated with anxiety and activation of the posterior (PCC) and middle (MCC) dorsal cingulate subregions. (2) Subjects with a history of abuse showed greater activation in the left MCC (P = .022; t = 5.61) and PCC (P = .033; t = 5.00) than subjects without abuse. (3) Those with IBS and abuse reported greater pain than all others (P = .004), had more activity in the left MCC (P = .021; t = 5.29) and PCC (P = .049; t = 4.81), and had less activity in the left supragenual anterior cingulate (sACC) (P = .01; t = 4.86). Conclusions: Pain ratings during rectal distention are associated with activation of dorsal cingulate regions implicated in homeostatic afferent processing, and prior abuse enhances this activation. Patients with IBS and abuse report more pain, greater MCC/PCC activation, and reduced activity of a region implicated in pain inhibition and arousal (sACC). These findings suggest a possible explanation for the clinical observation of greater pain reporting and poorer outcome in IBS patients with a history of abuse.

Section snippets

Materials and Methods

We studied 20 right-handed female subjects aged 18–65 (mean age, 27.6 ± 10.0 years) years. All subjects were recruited by advertising at UNC campus and UNC hospital general and GI clinics. Ten subjects had a diagnosis of IBS, and 10 subjects were without IBS. Non-IBS subjects served as controls and were completely asymptomatic with regard to any GI symptoms. Half of the subjects in each group reported a history of sexual and/or physical abuse (sexual abuse and physical abuse, n = 8; sexual

Results

The average age of our female study sample was 27.6 ± 10.0 years, average education was 13.8 + 2.0 years, and 65% were of white ethnicity. Abused subjects were less educated than the nonabused subjects (12.8 vs 14.7 school years, respectively) (P = .03), and those with IBS and abuse had less education than all other subjects (12.0 vs 14.3 school years, respectively) (P = .02). Subjects’ age was not different between the study subgroups.

Discussion

A history of abuse and other psychosocial factors is common in patients with IBS and can exacerbate GI symptoms, influence illness experience, and affect treatment outcome.2, 3, 4, 5, 6, 7, 8, 9, 36, 37 The association of a history of abuse with the diagnosis of IBS and its poorer outcome has suggested to some that abuse history may be associated with central mechanisms of pain amplification, resulting in greater pain reports and greater clinical behavioral responses to painful visceral stimuli.

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    Supported by K23 DK075621 (to Y.R.), DK48351, RO1 MH46959 (to D.D.), R24 DK067674 (to W.E.W. and D.D.), R24 AT002681 (to E.A.M.), P50 DK64539 (to E.A.M.), and RO1 DK48351 (to E.A.M.).

    Conflicts of interest: No conflicts of interest exist.

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